他克莫司致肾病综合征患儿急性肾损伤的高危因素分析

Risks Factors of Tacrolimus-induced Acute Renal Injury in Children with Nephrotic Syndrome

目的:总结分析他克莫司导致肾病综合征(NS)患儿发生急性肾损伤(AKI)的特点和高危因素。方法:收集我院因他克莫司导致AKI的7例NS患儿的临床资料、联合用药情况和实验室检查数据,分析该群体发生他克莫司相关AKI的特点。结果:除1例患儿外,其余6例患儿谷浓度均<10 ng·ml^(-1)。患儿从开始使用他克莫司到发生AKI的时间中位数为14 d。发生AKI后,4例患儿停用他克莫司,3例减量,此后患儿的肾功能均恢复。长期随访发现,除1例患儿由CKD 3期进展为CKD 5期外,其余6例患儿肾功能均稳定在正常水平。结论:NS患儿发生他克莫司相关AKI的高危因素包括:肾病综合征的未缓解状态、急性胃肠炎、感染和联合用药。存在高危因素的NS患儿使用他克莫司时,应注意监测尿量和肌酐,及时发现AKI情况。

Objective:To investigate the characteristics and risk factors of tacrolimus-induced acute renal injury(AKI)in children with nephrotic syndrome(NS).Methods:The clinical data,combination medications and laboratory data of 7 NS children who suffered from AKI in our hospital were collected retrospectively,and then the characteristics of tacrolimus-induced AKI were analyzed.Results:Except for one patient,the tacrolimus trough levels of the other 6 patients were lower than 10 ng·ml-1.Patients developed AKI at a median of 14 days after tacrolimus treatment.All AKI was recovered after tacrolimus reduced in 3 patients and discontinued in 4.After a long-term follow up,the renal function of six patients kept normal,whereas one patient with stage 3 CKD progressed to stage 5 CKD.Conclusion:The unrelieved state of NS,acute gastroenteritis,infection and drug combination were the risk factors of tacrolimus-induced AKI in NS children.When the above situation occurs in children with NS,urine volume and creatinine should be closely monitored in order to timely recognize tacrolimus-induced AKI.